A pilot study of daunorubicin-augmented hyper-CVAD induction chemotherapy for adults with acute lymphoblastic leukemia

Cancer Chemother Pharmacol. 2018 Feb;81(2):393-398. doi: 10.1007/s00280-017-3514-3. Epub 2018 Jan 2.

Abstract

Induction of complete remission (CR) is imperative for long-term survival in adult acute lymphoblastic leukemia (ALL) patients regardless of transplantation eligibility. Hyper-CVAD chemotherapy is a widely-used frontline remission induction regimen for these patients. We conducted a pilot trial of frontline remission induction using daunorubicin-augmented hyper-CVAD regimen (hyper-CVDD) in adult ALL patients (n = 15). The CR rate after this modified regimen was 100% (n = 15). Twelve patients were able to proceed to allogeneic hematopoietic cell transplantation, two patients died before transplantation due to infection, and the remaining one who was ineligible for transplant due to her age received an additional five courses of consolidation chemotherapy. Overall survival (OS) and event-free survival (EFS) of the study patients was 61.0 and 47.5% at 3 years. OS and relapse-free survival of transplanted patients was 66.8 and 55.0% at 3 years. This pilot trial demonstrates the favorable efficacy of the hyper-CVDD chemotherapy as a frontline remission induction regimen. Further clinical trials using this regimen are warranted.

Keywords: Acute lymphoblastic leukemia; Adult; Chemotherapy; Daunorubicin; Hyper-CVAD; Remission induction.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibiotics, Antineoplastic / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Blood Cell Count
  • Cyclophosphamide / administration & dosage
  • Daunorubicin / administration & dosage
  • Dexamethasone / administration & dosage
  • Doxorubicin / administration & dosage
  • Female
  • Hematopoietic Stem Cell Transplantation / methods
  • Humans
  • Induction Chemotherapy / methods*
  • Male
  • Middle Aged
  • Pilot Projects
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Recurrence
  • Remission Induction
  • Survival Analysis
  • Treatment Outcome
  • Vincristine / administration & dosage
  • Young Adult

Substances

  • Antibiotics, Antineoplastic
  • Vincristine
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide
  • Daunorubicin

Supplementary concepts

  • CVAD protocol